800.1. Except as otherwise specifically provided, this Act shall be administered by the CA Health Trust Fund Board, in partnership with the Secretary and their office and component Agency Departments and their staffs.
800.2. Advisory and decision-making participants in the CALTCHA program (and their families) must have no conflicting fiduciary or pecuniary interests.
801.1 The Board shall negotiate and fund all global budgets and direct reimbursements to participating providers of health care, allocate funds for capital infrastructure and major technology acquisition, and otherwise direct payments that achieve the intents and purposes of this Act.
801.2. The Board shall consist of twenty-nine (29) members determined by appointment, selection, or election from their respective defined constituencies for a period of two (2) or four (4) years, emphasizing representative democratic governance and accountability. The proposed makeup of the Board is as follows:
801.2.1. Governor's appointee [1*] * = number of positions
801.2.2. The Secretary [1]
801.2.3. CA State Senate Health Committee Chair appointee [1]
801.2.4. CA State Assembly Health Committee Chair appointee [1]
801.2.5. CA Neighborhood Assembly District Representatives designies [5 rotating members] Designees and Representatives of
801.2.6. CA State Association of Counties [1]
801.2.7. CA Conference of Local Health Officers [2]
801.2.8. California Association of Retired Americans [1]
801.2.9. CA Public Citizen [1]
801.2.10 Poor People's Campaign [1]
801.2.11. Disability Rights Defense and Education Fund (DREDF) [1]
801.2.12. Organized Labor Representatives [5]
801.2.13. National Assoc. of Social Workers, California Chapter [1]
801.2.14. California Medical Assoc., National and Hispanic Medical Associations [3]
801.2.15. CA Parent-Teacher Association [1]
801.2.16. CA Psychological Association [1]
801.2.17. CA Dental Association [1]
801.2.18. First Five Association [1]
801.3. The Secretary shall determine which Twelve (12) members shall be designated for the first two inaugural (2) years and then newly replaced. Members shall not exceed eight (8) years in office.
801.4. Twelve (12) members shall be designated for four (4) years and then newly replaced, not to exceed 8 years in office.
801.5. The twenty-four (24) members mentioned above shall be replaced in a manner identical to their original selection, that is, by public appointment, selection, or election from within their respective organizations or groups.
801.6. The five (5) Neighborhood Assembly Representatives shall be elected from the CA Neighborhood Health Assembly Association, each for three (3) years, and rotated onto the Board every three (3) years.
801.7. The Governor shall appoint an economically and organizationally conflict and nepotism-free, Chairperson of the Trust Fund Board, from within the twenty-nine (29) members, who shall possess an MD and MPH accreditation, a minimum of ten (10) years of service in public health, practical knowledge of global, national health care programs strengths and weaknesses, bilingualism and, preferentially, represent the evolving ethnic and gender majority of the CA population.
801.8 Any member may be removed by demonstration and charge of legal, financial, ethical, or moral impropriety brought by a majority of the Board followed by a majority vote for removal from the Board
801.9 Gubernatorial or legislatively appointed member's terms shall expire upon a subsequent CA election that may allow replacement by the newly elected appointing officials.
801.10 The CALTCHA Board shall convene semi-annual statewide work sessions to assemble representatives from Local Health Officers, Neighborhood Health Assembly Association District Representatives, and representatives from health professional associations to address Program developments, problems, and needs.
801.11 Board members, excluding those derived from the CA State government, shall receive salaries not to exceed $100,000 and operational out-of-pocket cost stipends for this work. The Secretary shall negotiate board staff salaries.
802.1. Twenty-one (21) Members shall include the gubernatorial appointed Directors of the eleven (11) Departments of the Health and Human Services Agency, whose chairperson shall be the Director of the State Department of Public Health.
802.2. Ten (10) experts chosen by the Board from professional fields are defined in this Act on Definitions section.
803.0 The intent of this section is to systematically augment and expand the existing statutory roles and functions of the Department of Public Health to:
803.0.1 Lead, define, and direct state universal health care and the public health functions of government to the benefit of all California individuals and households, and,
803.0.2 Assess statewide neighborhood-specific conditions and to expose and reverse the broader, disparate cumulative impacts of social, economic, and political injustices on the health of affected communities. These disparate effects result from housing discrimination, redlining, zoning, restrictive covenants, and other policies whose impact has been the exclusion of specific communities from services and resources and the consequent harm to their resident populations to make them vulnerable to illness and suffering and shorter lives.
803.1 A fundamental responsibility of the CA Department of Public Health (CA DPH) is to assess and address conditions of disparate impact in the delivery and outcomes of health care and services. This essential public health function shall be funded, prioritized, and expanded beyond existing statutory and regulatory mandates and programs to implement CALTCHA's broader goals, including, but not limited to, comprehensive local neighborhood health evaluation and personal care, infectious disease control and prevention, food safety, environmental health, laboratory services, patient safety, large scale emergency preparedness, chronic disease prevention, public education, and health promotion, family and reproductive health, health equity, vital records, and statistics.
803.2 CA DPH shall establish and apply CALTCHA values and standards to ensure the mandates and regulatory tools prescribed by the ACT for neighborhood, city, county, district, and statewide health services:
803.2.1 lead to universal health and wellness
803.2.2 coordinate improvements in the social determinants of health to revere disparities in health care delivery and outcomes; unremediated, current social determinants have led to existing structural health inequity in CA.
803.3 Protect Californians from the threat of public health emergencies and preventable infectious diseases, epidemics, and pandemics like COVID 19, Zika virus, HIV/AIDS, tuberculosis, and viral hepatitis.
803.4 4 Research and provide reliable public health data and accurate statewide and local public health laboratory services and information about health threats, population health, and wellbeing disparities.
803.5 Assure the provision of nutritional support and security to low-income women, infants, and children, and screen newborns and pregnant women for genetic, congenital, and acquired diseases and conditions.
803.6 Continue to address the safety of food, air, and water
803.7 Educate the public to reduce and end smoking, gun violence, substance abuse, and their attendant harms.
803.8 Work to prevent chronic diseases and conditions such as diabetes, hypertension, cardiovascular disease, cancers, asthma, addictions, and obesity.
803.9 Continue to protect patient safety by reducing iatrogenic harm in hospitals, clinics, and from all segregated, congregate, institutional, and community residential facilities.
803.10 Continuously target, prioritize and correct, health and mental health disparities among vulnerable and underserved communities to achieve health equity and wellbeing statewide.
803.11 Establish excellence in public health practices through the inclusion of neighborhood and community-based organizations in strategies for evaluating local public health conditions and prioritizing corrective action.
803.12 2 Establish general guidelines for local health officers in expanding local health information systems to include neighborhood health assessments, participatory budgeting, and periodic reporting for monitoring local population health conditions and designing corrective action plans.
803.13 Convene an annual conference among all the local public health officers to report on and discuss the progress, problems, and needs of the CALTCHA program's development prior to the Board's annual disbursement of funds derived from that fiscal year's budget determination.
803.14 4 Establish excellence in public health practices through the inclusion of neighborhoods and community-based organizations in strategies for evaluating local public health conditions and prioritizing corrective actions. This practice will build a trained and skilled workforce to evaluate communities' needs that determine evidence-based interventions. It will include substantial training and service opportunities for vocational, college, and university students to continuously nurture a skilled and culturally competent workforce that is representative of and responsive to local populations and their health needs.
804.1. Local administration of CALTCHA shall be the responsibility of fifty-eight 58 Local Health Officers (LHO) representing each county and three (3) members from city health offices [currently Los Angeles, Pasadena, and Long Beach, (though their numbers may increase) who shall assume responsibility for CALTCHA in their respective localities. Jurisdictions that possess less than 50,000 persons may choose to establish joint powers agreements with adjacent local health offices by an official vote.
804.2. Each Local Health Officer shall act as the chief administrator for CALTCHA program implementation in the county or city jurisdictions that they serve. They shall coordinate the work to develop prioritized county (or city) health system operational and transformational budgets as described in Title 2 (section 204) of this Act.
805.0 Intent: To guarantee that every person in California has access to health care and that actual health care delivery's positive economic and social effects reach every neighborhood. The Legislature is aware that universal health care coverage by itself is no guarantee of equal access to actual health care and that health care delivery remains a critical neighborhood asset essential for thriving and productive communities. Therefore, the Legislature further intends that neighborhoods experiencing the cumulative and persistent effects of racial, social, and economic segregation and all populations experiencing disparate unmet medical needs receive the appropriate level of services and new investments necessary to correct past neglect and underinvestment. CALTCHA implementation at the local level shall ensure that local health administration be supported through neighborhood-focused whole health information systems that identify persistent conditions of inequity and the consequent disparate rates of morbidity and mortality.
805.1 Using guidelines provided by CA DPH, Local Health Officers shall expand current health information systems to include periodic neighborhood health assessments that incorporate epidemiological investigative methodologies with direct neighborhood participation; a local budgeting process that prioritizes neighborhood participation and directs funding towards correcting negative findings from the assessments; and a periodic reporting system that provides the public with both qualitative and quantitative data regarding health outcomes and neighborhood health conditions requiring corrective action and resilience (prevention and recovery) planning by local and state agencies.
805.2 Neighborhood Health Assessments. The Local Health Officer shall create and deploy a standardized assessment tool and protocol based upon CA DPH guidelines for identifying neighborhood public health deficiencies and identifying conditions of disparate impact. The LHO shall conduct a triennial Neighborhood Health Assessment for each publicly known neighborhood within its jurisdiction. The assessment shall incorporate epidemiological methods using data-driven diagnostics for problem and asset identification that guide place-specific intervention and solutions planning at the neighborhood scale. The standardized health assessment protocol shall consider and incorporate cultural assets, practices, and neighborhood strategies used to compensate for inadequate health care delivery. The neighborhood assessment shall not be reduced to a review of aggregate data of individual health outcomes but emphasize a collaborative data -gathering and fact-finding process. The assessment protocol shall:
805.2.1 Identify adverse neighborhood public health conditions.
805.2.2 as a liaison activity of the LHO, coordinate with the responsible agencies to ensure that public health responsibilities funded by said agencies are succeeding in their purposes (e.g., that housing authorities are succeeding in sheltering the unhoused).
805.2.3 Consider the performance of hospital systems and public health functions that impact health outcomes and lead to disparate impact.
805.2.4 Consider neighborhood-oriented health strategies and culturally competent mediation functions as essential assets in the delivery of public health. Therefore, the LHO shall incorporate such components into the assessment design to facilitate collecting neighborhood-specific qualitative data on health care delivery.
805.2.5 5 Consider relevant hospital and clinic system data as part of the assessment protocol to identify neighborhood public health priorities and ensure that the most up-to-date, accurate, and reliable, place-specific metrics which include but are not limited to suicides, homicides, gun violence, diabetes, high blood pressure, smoking, and other addictions, mental health challenges, malnutrition, negative environmental impacts, and public and child health screenings for immunizations are incorporated into the assessment process and clarify where disparities persist.
805.2.6 consider findings in federally mandated (by the Affordable Care Act) Community Health Needs Assessments conducted by hospital systems that meet the Internal Revenue Tax Code Section 501(r) requirements. These studies shall not, however, replace the required Neighborhood Health Assessments prescribed by t his Act.
805.3 Periodic reporting and public information. The Local Health Officer shall create and maintain a system of public accountability that identifies the fiscal and administrative activities implemented and how such activities directly address the findings of the neighborhood health assessments, periodic plans, and budgeting priorities.
805.3.1 The LHO shall conduct annual surveys of all racially segregated, economically disadvantaged populations and rural areas where health disparities and economic isolation create vulnerability to unanticipated environmental disasters, economic calamities, or pandemics when service failures are likely to occur. Using CA DPH general guidelines, the surveys shall include qualitative epidemiological and social investigations of local conditions and not be limited solely to the use of available demographic and health data. Findings shall be used to inform the need for immediate corrective actions.
805.3.2 The LHO shall develop and maintain a public information dashboard with budget information and a health outcomes scorecard, publicly accessible via the internet that provides full transparent access to neighborhood assessment and budget data, relevant neighborhood-level and county-level aggregated health and hospital data, and available public health data sources on outcomes of social determinants.
805.3.3 The periodic reporting system shall also be used to assist in the early detection and potential effects of natural and social calamities that can result in adverse health conditions.
805.4 4 Participatory Budgeting. Local Health Officers are responsible for establishing the use of local Neighborhood Assembly assessment information to guide prioritized investment for interventions in the form of CALTCHA breakout of the local county (or where relevant city) budget. The budget shall provide sufficient information for agencies, community-based organizations, and interested parties to use in the public monitoring of implementation plans and expenditures associated with the plans and ensure transparency and collaboration in priority setting through a public process.
805.4.1 Using data from the Neighborhood Health Assessments, the coverage designated LHO shall utilize a public participatory budgeting process to prioritize interventions needed to correct existing disparate neighborhood health conditions and those aspects of social determinants that affect equitable public health outcomes.
805.4.2 2 The public participatory budgeting process shall include the direct participation of neighborhood residents, local community-based organizations, and other interested parties in establishing neighborhood priorities to be addressed in the needed local budget. Neighborhood priorities identified will be itemized and included in the annual CALTCHA budget.
806.1. The LHO shall establish its neighborhood liaison offices to cover and manage and coordinate local participation in neighborhood assessments, participatory budgeting, and periodic reporting. These shall flexibly and effectively be established in relation to population size, not to exceed 50,000 persons, and neighborhood network numbers.
806.1.1 The local offices shall coordinate the linking of area residents in need of navigation services to community health workers and increase access to health care services. The local offices shall also coordinate area educational and outreach programs to reduce health disparities and advance the public and population health mission.
806.2 The LHO shall ensure that each Neighborhood Liaison Office is appropriately funded and staffed by personnel with technical expertise in public health research, budget and program administration, community engagement, and service navigation that can support CALTCHA related functions of neighborhood health assessment, data information, and reporting systems, program planning and implementation, and information/educational outreach.
806.2.1. The Neighborhood Liaison Office shall promote local hiring to the maximum extent possible to ensure diverse, linguistic, and culturally appropriate delivery of all CALTCHA services.
806.2.2. The Neighborhood Liaison Office will also integrate health science students in its operations as described in Title 5 (Section 501) of this Act. Student involvement shall focus on developing and promoting young professional educational and employment pipelines for underserved populations, aimed at the long-term goal of building a community health-focused workforce that understands the communities it serves.
806.2.3 CALTCHA shall coordinate with existing Federally Qualified Health Centers (FQHC) and farmworker health services in supporting healthcare planning needs assessments, participatory budgeting, periodic reporting, and assurance of services mandated by CALTCHA.
806.3 Neighborhood Liaison Offices shall oversee and ensure needed CALTCHA services in each publicly recognized neighborhood located within an existing, defined political boundary. The Neighborhood Liaison Office shall be responsible for creating a local assembly of representatives, herein referred to as Neighborhood Health Assemblies (NHA), for each publicly recognized neighborhood within its district, which shall be defined in size and diversity to participate effectively in CALTCHA mandated neighborhood assessments, periodic reporting, and participatory budgeting activities.
806.3.1 The Liaison Office shall, to the maximum extent possible, contract with, assist in reimbursing or funding, and use existing civic advocacy bodies or organizations such as local neighborhood associations and councils, health districts, community-based organizations (CBOs), and similar public service agencies to recruit neighborhood assembly members. If no representative neighborhood organizations exist in a local area, the Neighborhood Liaison Office shall coordinate the establishment of one for this purpose within 12 months of the adoption of CALTCHA
807.0. Intent: Local representation and democratic participation in CALTCHA administration and implementation are fundamental to community-grounded needs determination and to ensuring equitable health care resource distribution and service accessibility. Effective resident outreach is required to further the CALTCHA mandate for locally oriented, culturally, and linguistically appropriate delivery of all health care services. The NHA shall convene Town Hall sessions as needed to engage their local area's populations.
807.1. The Neighborhood Health Assemblies shall be a locally organized and stipend-funded body of no less than fifteen (15) residents, with essential paid staff and representatives of public health and social service providers, in each neighbourhood in CA and whose purpose is to assist the local neighborhood liaison office in executing research and outreach protocols and conducting neighborhood health assessments, set priorities for correcting health disparities via the budgeting process, and assist in periodic reporting functions. Neighborhood Health Assembly members shall also:
807.1.1. Be trained and assist Local Liaison Offices by providing the cultural and social connectivity needed for population health strategies to be successful in every area, prioritizing medically underserved urban and rural areas.
807.1.2. be trained and advise the local neighborhood liaison office in the design, content, and implementation of the research protocol for conducting assessments, budgeting, and reporting.
807.1.3. Assist in identifying the need for neighborhood health and wellness campaigns and creating short and long-term programs to promote community residents' physical, social and mental health.
807.3 The composition of each local neighborhood assembly of no less than 15 residents shall reflect to the maximum extent possible the diversity of local populations by race, ethnicity, language, socio-economic status, age, gender identity, sexual orientation, disability, and other protected classes and marginalized groups.
807.3.1. NHA members shall be free of any fiduciary or ethical conflict of interest and not be an employee in any capacity of a currently elected public official or in a position to be enriched as a result of participation or association with a corporate medical enterprise that may also derive undue financial benefit from that member's participation on an NHA.
807.3.2. Term of service and termination procedures shall be standardized, to be determined by the LHO system in partnership with the CALTCHA Board.
807.3.3. The local health officer and personnel shall effectively staff and coordinate the establishment and formalization of the locally elected or designated Neighbourhood Health Assemblies (NHAs) within their County or City jurisdictions. This must take place no later than 6 weeks after the operational beginning of CALTCHA
807.4. CALTCHA shall establish an effective stipend standard such that NHA members be paid reasonable compensation for travel and service hours dedicated to assisting Neighborhood Liaison Offices in executing research, program, and outreach protocols to effect the purposes of this Act. The Board shall determine the hourly remuneration rate for NHA members no later than three (3) months after the enactment of CALTCHA. All NHA members shall receive the same hourly pay for service across the state.
807.5 A Statewide representative Neighborhood Health Assembly Association of members of the Neighborhood Assemblies shall be established by the CALTCHA Board to provide a cross-section of these bodies to address statewide and district policy and operational matters that exceed the scope of work at the local levels. This body shall elect the five (5) rotating NHA representatives on the CALTCHA Fund Board and those representatives who shall report/testify to the. State Legislature and CALTCHA Board.
808.1. The Neighborhood Health Assemblies shall each convene two (2) annual town hall meetings (purposed to initial framing and subsequent finalization of the triennial/annual budget request to the Fund Board) with the help of the local neighborhood liaison office.
808.1.1. Public comment from these town hall meetings must be placed on the Local Health Officer's website and relevant NHA public access information platforms.
808.1.2. The NHAs shall review and comment upon the Local Health Officer's CALTCHA Budget Proposal at least eighteen (18) days before it is submitted to the CALTCHA Board.
808.2 The Local Health Officer and neighborhood liaison offices shall coordinate with NHAs to engage and train other neighborhood residents to support neighborhood block gatherings, door-to-door health and wellness assessments, educational campaigns, annual town halls, and any programs that will help promote the physical and mental health of community residents and advance CALTCHA goals in ways focused on authentic local community need.
808.2.1 The LHO and NLO shall create curriculum for and repeat skill-building and training sessions designed to build and maintain NHA members' knowledge and capacity to perform annual neighborhood health assessments, execute periodic public reporting, and participate in community budgeting.
808.3. The CA Local Health Officers Association and the Board shall organize a statewide Annual System Review Conference to evaluate the status of health care system transformation and developments.
809.1. The twenty-one (21) member appointed by the Local Health Officer to advise the LHO on operations and policy, comprised of professional experts representing Public Health, Medicine, Nursing, Law, Economics, Epidemiology, Research Sciences, Hospital Leadership, Sociology, Business, Social Work, Voluntary Associations, and Interfaith organizations.
810.1 Eighteen (18) California District (conforming to California ACA Districts) Ombudspersons shall be appointed by the CALTCHA Board to officially, locally, represent the state's neighborhoods' needs in a manner that is unbiased and independent of elected officials and other interests. Ombudspersons shall serve three (3) year terms and may be renewed for 3 terms. The CALTCHA program shall fund these positions and support staff.
810.2. The CALTCHA Trust Fund Board will designate the eighteen (18) district ombudspersons. The number of NHAs each will represent so that each Ombudsperson maximally can advocate for NHAs in their district.
810.3. The Ombudsperson must have experience in conflict resolution, a background in policy and law, an understanding of health policy, experience working in local or state government, and experience in advocacy and community organizing.
810.4. Responsibilities of the Ombudsperson shall include: representing the NHAs when Local Health Officers and the NHAs do not reach an agreement on budget proposal; representing the NHAs in all CALTCHA Trust Fund Board funding negotiations related to health care or matters pertaining to the social determinants of health, and public health budget hearings in the California State Legislature.
810.5. Ombudspersons and representatives of NHAs shall testify bi-annually at the CALTCHA Trust Fund Board meetings and all relevant California State Legislature hearings related to CALTCHA health care, social determinants of public health, and disparate impacts in health care delivery systems and public health.
810.6. Grievance and appeal mechanisms shall be established to ensure fairness, balance, and equity regarding neighborhood-based priorities as they relate to established hospital and large institutional providers and their global budgets.